Provider Demographics
NPI:1710558218
Name:ROBERTSON, KRISTEN (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44150 W MARICOPA CASA GRANDE HWY
Mailing Address - Street 2:
Mailing Address - City:MARICOPA
Mailing Address - State:AZ
Mailing Address - Zip Code:85138-5900
Mailing Address - Country:US
Mailing Address - Phone:520-568-5100
Mailing Address - Fax:
Practice Address - Street 1:44150 W MARICOPA CASA GRANDE HWY
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85138-5900
Practice Address - Country:US
Practice Address - Phone:520-568-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ250330163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool